Provider Demographics
NPI:1396196507
Name:SANTOS, JOCELYN ULANG
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ULANG
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 32ND AVE
Mailing Address - Street 2:APT 607
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1440
Mailing Address - Country:US
Mailing Address - Phone:347-208-5100
Mailing Address - Fax:
Practice Address - Street 1:38 W 32ND ST STE 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3836
Practice Address - Country:US
Practice Address - Phone:518-364-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307776363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health